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General NPI Number Information
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NPI Number | 1649844507
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Entity Type | Organization
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Legal Business Name | OASIS PCH LLC
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Dates
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Enumeration Date | 05/16/2021
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Last Update Date | 05/16/2021
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Provider Practice Location Address
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Address Line | 1487 PANOLA RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30088-3305
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Country | US
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Telephone | 770-573-1076
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Fax |
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Provider Business Mailing Address
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Address Line | 1227 ROCKBRIDGE RD STE 208-196
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3064
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Country | US
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Telephone | 770-755-1394
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Fax | 770-220-1966
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Authorized Official
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Title or Position | COO
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Name | PATRICK GORDON
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Credential |
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Telephone | 404-432-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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